For foster kids, oversight of prescriptions is scarce

Foster
children are of special concern to some experts who fear atypical
anti-psychotics may be prescribed without the careful oversight usually
provided by birth parents.

The vigilant
medical monitoring that is needed by foster children on anti-psychotics
"is still unusual, unfortunately" in the USA, says Moira Szilagyi, a
Rochester, N.Y., pediatric endocrinologist who specializes in foster
children.

There are no numbers collected
nationally, but Paul Vincent of the Child Welfare Policy and Practice
Group believes there has been an upswing in the use of atypicals by
foster kids in the past few years. His Montgomery, Ala., firm consults
for state child welfare agencies, reviewing many of their health
services.

Some state data obtained by USA TODAY through Freedom of Information Act requests appear to support his observations.

•
In California, Med-Cal prescription claims for atypicals for kids in
foster care increased 77% between 2001 and 2005, to 70,879. The actual
number is probably higher because the state does not get complete data
from managed-care providers, which cover the majority of foster
children.

• In Illinois, the number of
children covered under the state's public health care program — not
just foster children — who had an atypical prescription went up 39%
between fiscal years 2003 and 2005, to 17,746.

Kids
as young as 4 are getting prescriptions for anti-psychotics, Vincent
says, sometimes from unqualified counselors. "They aren't psychiatrists
or even psychologists. I have considerable worry about the accuracy of
these diagnoses."

The safety of these drugs
is of most concern to Andrea Moore, a Coral Springs, Fla., attorney.
Judges appointed her to represent foster kids a few years ago. Several
children she represented started lactating after taking
anti-psychotics, a recognized side effect of the drugs. A 12-year-old
girl with a history of heart problems became short of breath on Geodon,
an atypical that can cause arrhythmias. "The doctor prescribing it did
not even have her medical history," Moore says.

Geodon
has a proven "modest" effect on heart rhythms in adults, says Ilise
Lombardo, medical director for the U.S. Geodon team at Pfizer Inc.,
maker of the drug. The clinical impact of this rhythm change is unknown
but is being studied in adults, she says; safety and effectiveness
studies in kids are underway, too. The drug's label says patients with
certain heart problems shouldn't take it.

In
February, Florida's health care agency ordered an independent
investigation into why the number of Medicaid children taking
anti-psychotics nearly doubled in the past five years. The numbers
jumped from 9,500 to 17,900.

A new Florida
law adds some protections for foster children, but it has loopholes,
Moore says. "I'm still hearing about problems with overprescribing and
under-monitoring."

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